Tuesday, October 19, 2010

Exit Externship :(

Well, it's over and it hasn't even been a week and I miss it already. I feel like I learned more in 120 hours of my externship than I did in all of nursing school. I am sure the truth is it just all finally started to come together for me.

I feel my preceptors were wonderful. They always provided feedback good and bad, but never in a condescending way and kept pushing me to take on more patients and nursing skills, even though at times I felt unprepared. I enjoyed the one on one experience much more with my nurse as she was there initially to guide me and help me get into good habits.

This rotation finally removed some of the doubts I had about my abilities as a competent nurse and replaced it with some confidence. I learned even if I don't know something, I have become independent enough to find the solution. My last 40 hours I was pretty much on my own, unless I needed medications out of the pixis or chemotherapy or blood were needed. My preceptor had thought I was proficient enough at pushing Zofran in an IV and I felt confident too. My last day I went to push some in a patient's IV and noticed it was D5 and not normal saline. I was quite unsure of the compatibility and did as I was instructed since day one. I was honest. I told the patient I was unsure of the compatibility and I wanted to check before I killed him. He laughed and thanked me for thinking of him. I left and checked -- they were not compatible. I was so glad I had trusted myself and admitted I didn't know! I went back stopped the pump, clamped the line flushed it with normal saline, pushed the Zofran and flushed it again with normal saline before starting the pump back up. I was so elated, I had not hurt my patient, maybe I could do this.

My second to last day had been very hectic. I got behind on my medications and my documenting, even one of my assessments wasn't done until 11:00am because the patient had been off the unit for a few hours. I tried to manage my time wisely, but every time I went to document, someone needed a medication or an IV was beeping or people wanted discharge. I didn't get frazzled, just realized I couldn't keep up. My two main priorities became getting a patient discharged and getting a sent tray for a patient that had one meal in two days due to NPO status that had been waiting for it for 4 hours! Needless to say the secretary had put in the tray for dinner and although we had ordered it at 2:30 pm and called four times it didn't arrive until I finally went upstairs to the pantry to personally pick it up. I left wondering why I had such a hard time taking care of my three patients. My only plan was, if I was waiting for chemo to be checked or hung or something else I couldn't participate in, I would be documenting, instead of standing and watching.

Friday, my last day, I went in and had two of the same patients and one new admit. It was by far, undoubtedly my best day of time management ever. I had everything done and nearly all my documenting with the exception of one patient note before noon. I couldn't believe it! I stayed past my 120th hour. I wanted to discharge a 57 year old woman with brain cancer and metastasis to the liver that had just signed a DNR the night before and was going home to brother-in-laws and sister's house with hospice care. The doctors explained to her that because her radiation was so recent another dose. It would undoubtedly cause necrosis of her brain tissue and the treatment would be as disabling as the disease. She and her sister gave me and my preceptor so many hugs as they left. They thanked us for all the wonderful care and support and all I could think was "that's it, that's all I can do and it's not enough." It was very hard to watch her get on the elevator and leave knowing that she was not going to beat her cancer.

My drive home was full of reflection about how much I had enjoyed the patient's, the nurses, everything about G-70, about how much I had learned and how much better I felt about maybe calling myself a nurse soon. I had had an awesome experience and could only hope to be lucky enough to go back as an employee after graduation.